Provider Demographics
NPI:1457525164
Name:MIAMI ASTURIAS HOME INC.
Entity type:Organization
Organization Name:MIAMI ASTURIAS HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-312-3723
Mailing Address - Street 1:10854 SW 69TH DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2008
Mailing Address - Country:US
Mailing Address - Phone:305-275-9640
Mailing Address - Fax:305-275-9640
Practice Address - Street 1:10854 SW 69TH DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2008
Practice Address - Country:US
Practice Address - Phone:305-275-9640
Practice Address - Fax:305-275-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11188310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142953100OtherPROVIDER MEDICAID NUMBER